Nearly a third of people with lupus take opioids for pain

Nearly one in three patients with lupus uses opioids, often for more than a year, according to a recent study in southeast Michigan.

There is little evidence that opioids effectively reduce pain from rheumatic diseases.

Patients with lupus, a chronic autoimmune disease, often suffer from inflammation and pain throughout their body.

“Rheumatic diseases, such as lupus, are a leading cause of chronic pain,” says Emily Somers, an associate professor of rheumatology, environmental health sciences, and obstetrics and gynecology at the University of Michigan Medicine.

“With the current opioid epidemic and evolving guidance related to opioid prescribing, we wanted to determine current levels of prescription opioid use in lupus,” says Somers, lead author of the paper in Morbidity and Mortality Weekly Report that examines prescription opioid use among adult patients with lupus in southeast Michigan.

‘Alarming’ findings

The research team examined data from the Michigan Lupus Epidemiology & Surveillance (MILES) Program, a cohort of more than 650 patients with and without lupus from southeast Michigan.

In the study of patients who shared a similar demographic background—462 adults with lupus and 192 adults without lupus—31% of patients with lupus used prescription opioids during the study period (2014-2015) compared to 8% of adults without the condition.

In addition, 68% of the patients with lupus using prescription opioids had used them for more than one year, and 22% were on two or more different opioid prescriptions.

“These findings were alarming because one in three patients with lupus were using a prescription opioid, with the majority of those for longer than a year, even though opioids may not be providing benefits and have harmful side effects,” Somers says.

“We were surprised to find such high-levels of prescription opioid use amongst patients with lupus and that they were over three times as likely to use prescription opioids as others in their community with similar sociodemographic backgrounds.”

Further, the study found that patients with lupus who had at least one emergency department visit in the last year were twice as likely to use prescription opioids compared to those patients with lupus who had not visited the emergency department.

“It is important for clinicians caring for patients with lupus, including providers in the emergency department, to be aware of the high levels of prescription opioid use in lupus,” Somers says.

Patients with lupus may be particularly vulnerable to long-term side effects of opioids, she adds.

“In addition to their underlying disease, patients with lupus generally receive immunosuppressive and glucocorticoid therapies, which already put patients at a higher risk for known adverse effects related to long-term opioid use,” Somers says.

Other options

There can be several causes of pain in lupus, including a high prevalence of centralized pain, or fibromyalgia, among people living with lupus. The source of pain therefore needs to be diagnosed accurately in order to treat patients with lupus properly, Somers says.

“Underused, but effective, non-opioid and non-drug strategies for pain management, as well as treatment directed at possible coexisting centralized pain syndromes, may be both safer and more effective than long-term opioids for reducing pain in this patient population.

“Examples of non-drug pain management include physical activity and self-management education about the patient’s chronic disease.”

The researchers hope the study inspires fellow health professionals to work towards strategies for reducing opioid use in patients with lupus, along with safer and more effective pain management.

“This level of opioid use signals a need for healthcare providers to consider effective non-opioid pain management strategies in these patients and to familiarize themselves with guidelines for opioid tapering and discontinuation when appropriate,” Somers says.

Source: Kylie Urban for University of Michigan

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